Does India’s Mental Healthcare Act, 2017 protect patients’ rights and dignity in institutions?

GS Paper 2

 Syllabus: Government policies and Interventions

Source: TH

Context:  NHRC in a recent report flagged the “inhuman and deplorable” condition of all 46 government-run mental healthcare institutions across the country (3 Central Run and the rest of state-run Institutions)

What is Mental Health?

It is a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively, and is able to make a contribution to her or his community. (WHO Definition)

• For the status of Mental disorders in India: Click here
• For a Range of Mental illnesses in society: Click here 

Mental Healthcare Act, 2017(MHA) has been called a “watershed moment for the right to health movement in India”. 

Provisions of MHA

• It discourages long-term institutionalization of patients and reaffirms the rights of people to live independently, and within communities.
  • This right is doubly guaranteed under the Rights of Persons with Disabilities Act of 2016
  • The previous act — the Mental Healthcare Act, 1987—prioritized the long-term institutionalization of mentally-ill people and provided disproportionate authority to judicial officers and mental health establishments.
• Attempt to Commit Suicide, not an Offence: A person who attempts to commit suicide will be presumed to be “suffering from severe stress’’ and shall not be subjected to any investigation or prosecution.
• Promotes community living: The government was made responsible for creating opportunities to access less restrictive options for community living — such as halfway homes, sheltered accommodations, rehab homes, and supported accommodations.
• Discourages using physical restraints (such as chaining), objects to unmodified electro-convulsive therapy (ECT)
• Establishment of Central Mental Health Authority and State Mental Health Authority
• It provides the following rights:
  • Right to Make an Advance Directive about how to be treated or not to be treated for the illness during a mental health situation.
  • Right to Appoint a Nominated Representative
  • Right to access mental health care
  • It pushes for the rights to hygiene, sanitation, food, recreation, privacy, and infrastructure.
  • Right to get free medicines
  • Right to protection from cruel, inhuman and degrading treatment
  • Right to live in an environment, safe and hygienic, having basic amenities
  • Right to legal aid 

What are the challenges to the implementation of the Act? (as highlighted by the NHRC report)

• Violation of Rights:
  • Illegal Confinement: The facilities are “illegally” keeping patients long after their recovery
    • NHRC found that almost 36.25% of residential service users in state psychiatric facilities were living there for one year or more
    • It violates Article 21 of the Constitution (which protects personal liberty)
  • Infringement of the human rights of mentally ill patients
• Infrastructure issues:
  • Shortage of facilities: There are issues of shortage of doctors, lack of infrastructure, lack of community homes, homes for assisted living and socio-economic opportunities
• Procedural Issues:
  • Non-compliance to MHA regulations by the institutions
  • A majority of the States have not established Central Mental Health Authority and State Mental Health Authority
  • Many States have not notified minimum standards which are meant to ensure the quality of MHEs
  • State Mental Health Authority – which was required to meet atleast four times every year, remained inactive until August 2022.
• Societal Issues:
  • The social stigma that looks at a person with mental illness as a “criminal” deserving of incarceration.
• Poor budgetary allocationand utilization of funds: It leads to Shelter homes remaining underequipped, understaffed, and undertrained

Initiatives taken:

• Global Initiatives:
  • World Mental Health Day is observed on 10th October every year
  • WHO’s Comprehensive Mental Action Plan 2013-2020
  • The Mental Health Atlas was launched by WHO in 2017
  • Suicide prevention (under SDG 3.4)
• India:
  • The Ministry of Health and Family Welfare announced a National Suicide Prevention Strategy in November 2022
  • National Mental Health Program (since 1982)
  • District Mental Health Programme (since 1996)
  • Kiran Helpline (since 2020): a 24/7 toll-free helpline
  • Manodarpan Initiative (by Ministry of Education)
  • MANAS Mobile App (since 2021): It promotes mental well-being across age groups.
• State initiatives:
  • Chennai’s Institute of Mental Healthlaunched five halfway homes, in collaboration with an NGO: Here people can access the confidence and skills needed to manage themselves outside a structured institution.
  • Kerala has also started half-way homes and community living centres
• CSO/NGOs: “The Live Love Laugh Foundation”  aims to reduce the stigma, spread awareness and change the way we look at Mental Health
• Unique Initiatives: Taanvi Arekapudi’s book “Uplift Teens Today” (Check today’s CME)

Insta Links:

• Mental Health at Work
• Towards a stronger Mental Health Strategy

Mains Links:

Q. Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All ‘in India. Explain. (UPSC 2018)

Q. Mental health is one of the most neglected social issues in India. Comment. (10M)